Improving diagnostic accuracy in neonates with left heart obstruction in a transport setting

Abstract

Aim Differentiating left heart obstruction (LHO) from other severe illness in the neonatal period is challenging, and important for guiding clinical management. The aim of this study was to identify factors distinguishing LHO from non‐LHO in neonates. Methods A retrospective, cohort study of neonates referred to the Newborn and Paediatric Emergency Transport Service, New South Wales, with suspected LHO during the epoch 1996–2016. Results A total of 273 neonates were included; 240 with confirmed LHO. Administration of prostaglandin E1 to infants with a structurally normal heart was not associated with impaired acid–base or oxygenation status. Pre‐transport diagnostic accuracy of LHO was 74.4%; sensitivity 84.5%, positive predictive value 86.0%. On multivariable logistic regression, hepatomegaly (odds ratio 2.54; 95% confidence interval 1.05–6.16) was associated with confirmed LHO. Conclusions A low threshold for prostaglandin E1 infusion should be maintained in infants with suspected LHO. Hepatomegaly is associated with a diagnosis of LHO and may be more useful than other parameters in predicting the condition.

The impact of acidosis on the developmental outcomes of neonates with postnatally diagnosed left heart obstruction

“…Left heart obstruction (LHO) is congenital heart disease (CHD) characterised by obstruction to systemic outflow, encompassing hypoplastic left heart syndrome (HLHS), aortic stenosis (AS), interrupted aortic arch and aortic coarctation (CoA). Infants diagnosed postnatally may become profoundly acidotic 1 . Most infants with CHD survive surgery, however, are at risk of neurodevelopmental delay (NDD) 2 .…”

“…Infants diagnosed postnatally may become profoundly acidotic. 1 Most infants with CHD survive surgery, however, are at risk of neurodevelopmental delay (NDD). 2 Factors associated with NDD following CHD include genetic disorders, complex lesions, cardiopulmonary bypass duration, prolonged hospitalisation and low birthweight.…”